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Real-life data from various countries have shown that long-term use of a cannabinoid is possible for the treatment of certain chronic pain conditions, without risk of addiction and with maintenance of an overall benefit on quality of life. The retrospective evaluation presented considers the duration of dronabinol treatment for neuropathic pain in a Center for Pain Evaluation and Treatment (CETD). Between 2016 and 2023 (7 years and 2 months), 165 patients were followed up, 57 % with central pain (DNC) and 43 % with peripheral pain (DNP). Various data were collected once a quarter: analgesic efficacy, adverse events, overall benefit of treatment. Continuation of treatment was considered in the absence of contraindication or treatment-related adverse event, and when the patient requested continuation of treatment without increase in dosage because overall benefit was maintained. The duration of dosage adjustment varied between 1 and 4 months, and daily doses were stable for each patient, ranging from 2.5 to 40 mg. 64 % of patients discontinued treatment within the first 12 months, 44 % within the first 6 months due to inefficacy or intolerance. After 6 months, reasons for discontinuation were never adverse effects or addiction. During the first 2 years, 78 % of patients stopped treatment. At the end of the study, the longest duration of treatment was 7 years and 2 months. Mean duration of treatment was 17 ± 22 during the evaluation. Mean duration of treatment for patient still taking the treatment at the end of evaluation was 41 ± 4 months with DNC (95 % CI: 33–49) and 25 ± 3 months with DNP (95 % CI: 19–31). The proportion of patients receiving treatment for at least 1 year was 68.4 % (39/57) with DNC and 40.8 % (20/49) with DNP, the difference being statistically significant between the 2 groups only at 2 years of treatment (DNC: 39.1 % (27/69) and DNP 17 % (10/59), p = 0.038). The probability of time remaining before a patient stopped treatment was significantly different between the DNC and DNP groups (p = 0.023). With the advent of medical cannabis in France, the real-life data from our study and the literature show that the long-term use of a cannabinoid for the treatment of DN can be envisaged without any major risk, whether addictive or otherwise, and that it can provide a significant and durable benefit in terms of quality of life, justifying its use as a last-line treatment, with a focus on central pain. [ABSTRACT FROM AUTHOR]

The document presents a new issue of the journal "Pain and Analgesia" featuring articles on pain related to Covid-19, non-specific low back pain, the management of neuropathic pain with dronabinol, and the evaluation of the risk of post-surgical chronic pain. The 50th annual IASP congress in Amsterdam was marked by historic conferences and discussions on inequality in pain management and central sensitization. The next World Pain Congress will take place in Bangkok in two years. [Extracted from the article]

The CNRD press review recommends articles on the management of non-cancer chronic pain, the impact of non-pharmacological interventions on opioid use, the discordance between pain specialists and patients on analgesic dependence, the Merleau-Ponty approach to pain, and the skills needed to provide psychologically informed care. These articles highlight important aspects of pain and associated treatments, offering diverse perspectives for research and clinical practice. [Extracted from the article]

Background Until recently, treatments for chronic pain commonly relied on in-person interventions, and despite more hybrid care options today, capacity for delivery remains challenged. Digital programs focusing on the psychosocial aspects of pain may provide low-barrier alternatives.Aims Through a randomized controlled trial, we investigated the effectiveness of a multimodal mobile application.Methods Participants (n = 198; 82% women, mean age = 46.7 [13.1] years; mean pain duration 13.6 [11.2] years) with nonmalignant chronic pain were randomized to either a 6-week intervention (n = 98) or a wait-listed usual care group (n = 100). The intervention involved regular engagement with a user-guided mobile application (Curable Inc.) informed by the biopsychosocial model of pain that included pain education, meditation, cognitive behavioral therapy, and expressive writing. The co-primary outcomes were pain severity and interference at 6 weeks.Results We observed significant improvements in the intervention group compared to the control group with estimated changes of −0.67 (95% confidence interval [CI] −1.04 to −0.29, P

Introduction. Inadequate control of cancer pain represents an escalating public health concern in Africa, particularly within francophone regions, amidst a concurrent surge in cancer incidence. This study aims to enhance comprehension of the impediments to effective cancer pain management utilizing opioid analgesics in francophone Africa which is sparsely documented in the scientific literature compared to the rest of the world, particularly in the English-speaking countries. Methods. A double phased Survey engaged experts and field clinicians specialized in cancer pain management: 1) Expert questionnaire: a contemporary assessment of the organizational, legislative, and societal landscape at the national or regional scale; 2) Clinician questionnaire: an exploration of practices, identified needs, perceived barriers, and strategies to improve Pain management at local level. Results. A cohort of twelve experts and sixty clinicians from 15 countries diligently completed the surveys. A robust consensus emerged delineating four primary barriers: insufficient human resources with requisite competencies and dedicated facilities, constraints entailing opioid analgesic prescription, limited drug availability compounded by challenges in accessibility, and the economic burden borne by patients. Conclusion. Remedying the often-dire scenario in francophone Africa necessitates a multidimensional endeavour. Critical components encompass training in pain management and palliative care and safe opioids prescription, optimizing drug availability, affordability, and distribution networks, formulating clinical recommendations tailored to the specifics of francophone Africa taking in consideration local contexts and socio-cultural aspects, mitigating prescription constraints, and fostering heightened awareness across all pertinent stakeholders while always minimizing the risks related to opioids. [ABSTRACT FROM AUTHOR]

Background and Objective: Myofascial pain syndrome (MPS) is a chronic musculoskeletal disorder characterized by the presence of trigger points. Among the treatment options, botulinum toxin injections have been investigated. The aim of this paper was to provide a synthesis of the evidence on intramuscular botulinum toxin injections for upper back MPS. Databases and Data Treatment: A systematic review of the literature was performed on the PubMed, Scopus and Cochrane Library, using the following formula: ("botulinum") AND ("musculoskeletal") AND ("upper back pain") OR ("myofascial pain"). Results: Ten studies involving 651 patients were included. Patients in the control groups received placebo (saline solution) injections, anaesthetic injections + dry needling or anaesthetic injections. The analysis of the trials revealed modest methodological quality: one "Good quality" study, one "Fair" and the other "Poor". No major complications or serious adverse events were reported. Results provided conflicting evidence and did not demonstrate the superiority of botulinum toxin over comparators. Most of the included trials were characterized by a small sample size, weak power analysis, different clinical scores used and non-comparable follow-up periods. Even if there is no conclusive evidence, the favourable safety profile and the positive results of some secondary endpoints suggest a potentially beneficial action in pain control and quality of life. Conclusion: The currently available studies show conflicting results. Their overall low methodological quality does not allow for solid evidence of superiority over other comparison treatments. Further insights are needed to properly profile patients who could benefit more from this peculiar injective approach. Significance: The randomized controlled trials included in this review compared using botulinum toxin to treat upper back MPS with placebo or active treatments (e.g., dry needling or anaesthetics) showing mixed results overall. Despite the lack of clear evidence of superiority, our study suggests that the use of botulinum toxin should not be discouraged. Its safety profile and encouraging results in pain control, motor recovery and disability reduction make it an interesting treatment, particularly in the subset of patients with moderate to severe chronic pain and active trigger points. To support the safety and efficacy of botulinum toxin, further high-quality studies are needed. [ABSTRACT FROM AUTHOR]

Low back pain is a real public health problem. Today's pain management programs use drug treatments in addition to non-drug therapies. Osteopathic manipulative treatment (OMT) is presented here: a study of 48 patients suffering from type L5 low back pain and treated osteopathically. The treatment consisted of a Osteo-pathic protocol in 2 sessions (OP2S), developed at the Nouméa pain center (New Caledonia), in which L5 manipulation is performed only in the second session. Of the 48 patients included, 46 were treated, 41 were cured or improved at one year after treatment with two sessions (89%), and 28 were cured or improved from the first session (61%). In cases of type L5 low back pain, local osteopathic treatments were sometimes aimed at osteopathic manipulation of the L5 vertebra. We believe that this local manipulative treatment is delicate in the first line, as L5 inflammation is often secondary to nearby or distant osteopathic dysfunctions. Conclusion This first study from the PO2S research project suggests that osteopathic proto-colization is possible, osteopathy has a place in the type L5 low back pain treatment, and L5 manipulation is unnecessary in 61% of cases. Randomized studies will have to confirm these hypotheses. [ABSTRACT FROM AUTHOR]

For this first issue of 2024, the editors felt that circumstances called for an article to celebrate a number of events. Pain and Analgesia is the leading French-language journal for clinicians and researchers working in the field of pain. It is the official organ of the French Society for the Study and Treatment of Pain and is also an affiliate of the Swiss and Belgian societies. On the Canadian side, we are delighted to have the support of our Quebec colleagues, who have been an enrichment to our editorial team with the dynamism of their research. We are therefore delighted to welcome John Libbey Eurotext as the new publisher of the journal. This will enable us to continue to develop the journal and offer readers new content. This new edition of the journal now includes a quarterly press review. The first issue of the year is longer than usual as it celebrates the 50th anniversary of the IASP (International Association for the Study of Pain) and some of the French-speaking personalities who have contributed to its development. You'll therefore find a few tributes to start with, before going on to look at the Press Review. The press review will take stock of the articles that have been most frequently quoted over the last 50 years. We will then look at 5 major articles from 2023, before presenting the first 'nuggets' from the first quarter of 2024. [ABSTRACT FROM AUTHOR]

These proposed recommendations have been issued as part of an innovative approach based on an individualised, structured and coordinated patient pathway to engage patients in specific implanted neurostimulation (NSI) management for pain relief in the context of certain chronic pain conditions. This pathway necessarily involves chronic pain structures (SDC) and implantation centres (CI). This work takes the form of recommendations at several levels. We will distinguish between what is required, what is expected and what is desired in terms of good practice, depending on local and regional resources, in order to ensure optimal quality of care. [ABSTRACT FROM AUTHOR]

Background Chronic musculoskeletal (MSK) pain disproportionately affects Indigenous Peoples, and rural/remote communities face significant barriers in accessing care. La Loche, a Dene/Métis community in northern Saskatchewan, has limited access to specialized chronic pain management services and specialized health providers.Aims The aim of this needs assessment was to gain insight into the community’s priorities, strengths, and concerns regarding chronic MSK pain management. Community engagement and relationship building were essential to ensure that cultural protocols were respected and community worldviews were accurately represented.Methods A community-directed needs assessment was conducted in collaboration with local health care providers and community members. To ensure appropriate representation of community-led priorities, reflexive thematic analysis was utilized and rooted within interpretive description and informed by community-based participatory research and Two-Eyed Seeing. Open discussions were conducted in person, over the phone, or via Zoom in a semistructured format. Thirteen individuals were interviewed (eight community members, five health care professionals).Results Interviews conducted with community members and health care providers were analyzed separately. Both yielded the same four major overarching themes: (1) impact of pain on daily living, (2) barriers limiting access to care and the understanding of pain between health care provider and patient, (3) systemic oppression and negative experiences with health care, and (4) strength-based solutions.Conclusions Five recommendations were developed to promote culturally safe and patient-centered environments for chronic MSK pain communication and future care delivery: (1) person-centered and community-directed care, (2) clinic model and staffing requirements, (3) practitioner education and awareness, (4) community education and awareness, and (5) community resources.

Copyright of Psycho-Oncologie is the property of Tech Science Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Psycho-Oncologie is the property of Tech Science Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Management international / International Management / Gestiòn Internacional is the property of Management International and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ABSTRACTBackground Adults with chronic pain have a lower quality of life (QOL) compared to the general population. Chronic pain requires specialized treatment to address the multitude of factors that contribute to an individual’s pain experience, and effectively managing pain requires a biopsychosocial approach to improve patients’ QOL.Aim This study examined adults with chronic pain after a year of specialized treatment to determine the role of cognitive markers (i.e., pain catastrophizing, depression, pain self-efficacy) in predicting changes in QOL.Methods Patients in an interdisciplinary chronic pain clinic (N = 197) completed measures of pain catastrophizing, depression, pain self-efficacy, and QOL at baseline and 1 year later. Correlations and a moderated mediation were completed to understand the relationships between the variables.Results Higher baseline pain catastrophizing was significantly associated with increased mental QOL (b = 0.39, 95% confidence interval [CI] 0.141; 0.648) and decreased depression (b = −0.18, 95% CI −0.306; −0.052) over a year. Furthermore, the relationship between baseline pain catastrophizing and the change in depression was moderated by the change in pain self-efficacy (b = −0.10, 95% CI −0.145; −0.043) over a year. Patients with high baseline pain catastrophizing reported decreased depression after a year of treatment, which was associated with greater QOL improvements but only in patients with unchanged or improved pain self-efficacy.Conclusions Our findings highlight the roles of cognitive and affective factors and their impact on QOL in adults with chronic pain. Understanding the psychological factors that predict increased mental QOL is clinically useful, because medical teams can optimize these positive changes in QOL through psychosocial interventions aimed at improving patients’ pain self-efficacy.

Intrathecal drug delivery is an interventional procedure for patients suffering refractory pain despite high daily dosages of pain killers or due to treatment adverse effects. Low doses of analgesics are infused inside the cerebrospinal fluid (CSF) close to the spinal cord receptors through a catheter connected to an internal or external pump. The main advantage is an improved pain relief and a significant decrease of adverse effects rate. Despite the publication of evidence hightlighting the intrathecal analgesia efficacy and the recommendations [European Society for Medical Oncology (ESMO), Haute autorité de santé (HAS), etc.], the developpement of this technique remains limited for cancer patients. The development of this technique remains limited for cancer patients. The purpose of this article is to offer readers the tools to facilitate access to the technique, to deal and overcome obstacles. The patient's journey is detailed, including the initial barriers, the indications, technical concerns, complications, the key role of pharmacists, and other health care providers. [ABSTRACT FROM AUTHOR]

Copyright of Biologie Aujourd'hui is the property of EDP Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives CARD (comfort, ask, relax, distract) is a vaccine delivery framework that includes interventions to improve the patient’s experience. CARD has not been previously implemented in long-term care (LTC) settings. This study evaluated drivers to implementation for COVID-19 vaccinations in an LTC facility.Methods Postimplementation interpretive evaluation including qualitative interviews and quantitative surveys with eight participants. The Consolidated Framework for Implementation Research (CFIR) was used for analysis. Adverse reactions to vaccinations and CARD interventions, including local reactogenicity and systemic reactions, were abstracted from medical charts of residents.Results Eight CFIR constructs emerged. Staff perceived CARD was complex because it added steps to vaccination delivery. Motivated to meet residents’ needs, a receptive implementation climate of support among staff led to using strategies within CARD, such as administering topical anesthetics and omitting alcohol skin antisepsis prior to injections. Having an effective network like the residents council positively influenced implementation by allowing residents to voice their opinions. Facilitators to implementation included staff knowledge and beliefs and staff’s commitment to their organization, which was focused on person-centered care. Barriers included lack of available resources (inadequate staffing), insufficient communication between management and staff and lack of awareness of CARD, and external policies not aligned with CARD. Chart reviews conducted for 93 vaccinated residents corroborated perceptions of vaccination and CARD intervention safety, revealing a low rate of local and systemic adverse reactions and no cases of skin infection.Discussion We identified positive and negative implementation drivers. Future research is recommended to expand the strategies employed and involve residents more directly.

Background National strategies from North America call for substantive improvements in entry-level pain management education to help reduce the burden of chronic pain. Past work has generated a valuable set of interprofessional pain management competencies to guide the education of future health professionals. However, there has been very limited work that has explored the development of such competencies for individual professions in different regions. Developing profession-specific competencies tailored to the local context is a necessary first step to integrate them within local regulatory systems. Our group is working toward this goal within the context of entry-level physiotherapy (PT) programs across Canada. Aims This study aimed to create a consensus-based competency profile for pain management, specific to the Canadian PT context. Methods A modified Delphi design was used to achieve consensus across Canadian university-based and clinical pain educators. Results Representatives from 14 entry-level PT programs (93% of Canadian programs) and six clinical educators were recruited. After two rounds, a total of 15 competencies reached the predetermined endorsement threshold (75%). Most participants (85%) reported being “very satisfied” with the process. Conclusions This process achieved consensus on a novel pain management competency profile specific to the Canadian PT context. The resulting profile delineates the necessary abilities required by physiotherapists to manage pain upon entry to practice. Participants were very satisfied with the process. This study also contributes to the emerging literature on integrated research in pain management by profiling research methodology that can be used to inform related work in other health professions and regions.

Background The Canadian Pain Task Force recently advanced an action plan calling for improved entry-level health professional pain education. However, there is little research to inform the collaboration and coordination across stakeholders that is needed for its implementation.Aims This article reports on the development of a stakeholder-generated strategic plan to improve pain education across all Canadian physiotherapy (PT) programs.Methods Participants included representatives from the following stakeholder groups: people living with pain (n = 1), PT students and recent graduates (n = 2), educators and directors from every Canadian PT program (n = 24), and leaders of Canada’s national PT professional association (n = 2). Strategic priorities were developed through three steps: (1) stakeholder-generated data were collected and analyzed, (2) a draft strategic plan was developed and refined, and (3) stakeholder endorsement of the final plan was assessed. The project was primarily implemented online between 2016 and 2018.Results The plan was developed through five iterative versions. Stakeholders unanimously endorsed a plan that included five priorities focusing on uptake of best evidence across (1) national PT governance groups and (2) within individual PT programs; (3) partnering with people living with pain in pain education; (4) advocacy for the PT role in pain management; and (5) advancing pain education research.Conclusion This plan is expected to help Canadian stakeholders work toward national improvements in PT pain education and to serve as a useful template for informing collaboration on entry-level pain education within other professions and across different geographic regions.

Background Chronic pain (CP) is a debilitating disease that reduces quality of life, decreases productivity, and has become a primary cause of health care resource consumption. Despite this, many Canadian family physicians have received little formal education in managing CP, making it one of the most challenging areas of practice in primary care. Project Extension for Community Healthcare Outcomes Chronic Pain & Opioid Stewardship St. Joseph’s Care Group (Project ECHO-SJCG) is an evidence-based educational program connecting community-based health care providers (HCPs) with an interprofessional team by videoconference to learn about management of CP in rural, remote, and underserved areas.Aims To explore key learning points from cases presented at Project ECHO-SJCG, identify and analyze themes and improve future sessions of continuing professional development for HCPs.Methods We completed a thematic analysis of forty cases and key learning points using the constant comparison method. We also summarized descriptive statistics for patient and provider characteristics.Results Forty cases were presented by 31 HCPs, who received suggestions focused on assessment and diagnosis, pharmacological and non-pharmacological pain symptom management, interventional management, attention to biopsychosocial factors, and appropriate referral to other HCPs.Conclusion Project ECHO-SJCG cases allow HCPs to gain a broad knowledge base to evaluate and manage CP in their practice. Identified themes highlight common gaps in HCPs’ knowledge and will guide future sessions.

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Résumé: En oncologie, l'antalgie est un enjeu majeur de la prise en charge du patient. La « Patient-controlled analgesia » est une méthode permettant au patient de gérer lui-même sa douleur, mais elle n'est pas toujours applicable en cas de transfert des patients. L'objectif de ce travail a été de valider l'utilisation d'un dispositif portable d'intérêt permettant de mimer l'action de pompes électriques pour deux molécules : morphine et oxycodone. Des études de stabilités ainsi que la vérification de la conformité des spécificités vis-à-vis du débit ont été étudiées, en parallèle une réflexion sur le circuit de dispensation a été menée. Les deux molécules sont stables sur une durée d'au moins 30 heures. Une conformité de la valeur des débits a pu être montrée. Le circuit « prescription – dispensation – administration » a été définit et sécurisé. Ceci a pu permettre de valider et de mettre en place l'utilisation de ce dispositif. In oncology, analgesia is a major issue in patient management. "Patient-controlled analgesia" (PCA) is a method that allows patients to manage their own pain, but it is not always applicable when patients are transferred. The objective of this work was to validate the use of a portable device allowing to mimic the action of electric pumps use for PCA. For this purpose, two drugs were studied and analyzed. Stability studies, as well as the verification of the conformity of the specificities with regard to the flow rate were studied, in parallel a reflection on the dispensing circuit was carried out. Both molecules are stable for at least 30 hours. Compliance of the flow rates was demonstrated. The "prescription – dispensation – administration" circuit was defined and secured. These tests allowed us to "validate" this device and to use it in real life. [ABSTRACT FROM AUTHOR]

Résumé: La mésothérapie est une technique médicale qui consiste à injecter à plusieurs reprises de faibles doses de médicaments dans les couches superficielles de la peau. Elle vise notamment les pathologies musculosquelettiques, dont la prise en charge passe par certains médicaments potentiellement porteurs d'effets indésirables. Par sa voie intradermique, elle pourrait présenter plusieurs avantages, mais également des inconvénients comme le risque infectieux. Les protocoles hétérogènes et le faible niveau de preuves des articles publiés questionnent sur son efficacité. Mesotherapy is a medical technique that involves repeatedly injecting low doses of drugs into the surface layers of the skin. It is targeted in particular for musculoskeletal diseases, the management of which requires certain drugs that may have adverse effects. By its intradermal route, it could present several advantages, but also disadvantages such as the risk of infection. The heterogeneous protocols and the low level of proof of the published articles question its effectiveness. [ABSTRACT FROM AUTHOR]

Painful procedures in intensive care are numerous. The aim of the study was to assess the management of pain associated with care in an intensive care unit (ICU). This was a descriptive and prospective study running from January to April 2019. All patients over 18 years admitted to the ICU of the Yaoundé Central Hospital who receive a painful care were included. The patient's consent or that of his family member was obtained. The variables evaluated were the care provided, the intensity of the pain, the management of the pain and the effectiveness. Pain intensity was assessed with the visual analogue scale (VAS) in conscious patients and with the Critical-care Pain Observation Tool (CPOT) in unconscious patients. Data were analyzed using SPSS 17.0 software. The sample was 102 patients. The mean age was 36.7 ± 15.6 years. The sex ratio was 0.64. The most frequent care was the dressing (18.6%). The preventive treatment was non-drug (88.8%) and drug (11.2%). No curative treatment has been given to the patients. The most painful treatments for conscious patients were dressings (12.7%). In unconscious patients, the most painful treatments were intubation (3.9%) and tracheal aspiration (2.9%). Management was not effective (n=64, 62.7%). The management of care related pain was not effective and adequate. The establishment of protocols would be an area for improvement [ABSTRACT FROM AUTHOR]

The article informs on several medical studies. Topics include Lyme disease is a major source of societal concern; promote access to prescription of synthetic opioids for pain patients and in particular cancer patients; and a data on the excess male mortality in France for deaths from Covid-19 pandemic.

Background Painful experiences are common among hospitalized children. Long-term negative biopsychosocial consequences of undertreated pain are recognized. Aims The study benchmarks pain prevalence, assessment, and treatment as first steps to improve pain care in a Canadian tertiary hospital. Methods Single-day audits were undertaken on the pediatric ward (PW), pediatric emergency department (ED), and maternal services (MS). Participants (child or caregiver proxy) reported hospital pain experiences in the preceding 24 h; medical records were reviewed for assessment and treatment. Results Among 84 participants, pain prevalence ranged from 75% to 88%; mean pain intensity ranged from 5.7 to 6.5/10. Prevalence of moderate to severe pain was 78% on PW, 65% in ED, and 55% on MS; needle pokes were the most frequent cause of worst pain. Documentation of pain assessment varied by setting (PW, 93%; ED, 13%; MS, 0%). Documented maximum pain scores were significantly lower compared to participant report (mean difference 4.5/10, SD 3.1, P

Background: Injections, particularly paravertebral blocks (PVBs), are frequently performed procedures in Ontario, Canada, for the management of chronic pain, despite limited evidence and risk of complications. Aim: This study examines usage patterns of PVBs to evaluate their effects on healthcare utilization and opioid prescribing. Methods: A retrospective cohort study in Ontario using administrative data. Ontario residents receiving their initial PVBs between July 1, 2013 and March 31, 2018 were included. Changes in use of other interventions, physician visits, and opioids were compared to the 12-month periods before and after index PVBs. Data use was authorized under section 45 of Ontario’s Personal Health Information Protection Act. Results: 47,723 patients received their initial PVBs in the study period. The rate of index PVBs increased from 1.61 per 10,000 population (2013) to 2.26 per 10,000 (2018). Initial PVBs were performed most commonly by family physicians (N = 25,042), followed by anesthesiologists (N = 14,195). 23,386 patients (49%) received 1 to 9 repeat PVBs in the 12 months after index PVB; 12,474 patients (26.15%) received 10 or more. Use of other nonimage guided interventional pain procedures per patient (mean±SD) increased from 2.19 ± 9.35 to 31.68 ± 52.26 in the year before and after index PVB. Relevant physician visits per patient (mean±SD) also increased from 2.92 ± 3.61 to 9.64 ± 11.77. Mean opioid dosing did not change significantly between the year before and the year after index PVB. Conclusion: PVBs are associated with increases in healthcare utilization and no change in opioid use patterns.

Introduction: Oligoanalgesia is the inappropriate use of analgesics. It is a problem that is still prevalent in emergency departments. The main objective of this study was to conduct an inventory of pain management in the emergency department of the Al Mansour prefectural hospital in Casablanca and to determine the factors associated with oligoanalgesia. Material and methods: This is a cross-sectional study, carried out during the month of April 2019, through a heteroquestionnaire administered and completed by emergency room prescribers during this period. They informed their evaluation of pain via the numerical scale of patients who declared themselves to be in pain and completed their sociodemographic and clinical data as well as their management. Results: Of the 475 patients admitted to the emergency department, 64.2% presented with pain. The average age of these patients was 36 (± 17) years. Trauma was the most frequent cause of pain (55.7%). Eighty percent of the patients received analgesics. More than half of the patients (53.5%) were not relieved at discharge from the emergency department. The factors associated with this oligoanalgesia were: male gender (ORa = 1.98 [1.20-3.27]), the absence of pre-hospital analgesic medication (ORa = 3.31 [1.81-6.04]) and the absence of non-drug analgesia in the emergency room (ORa = 6.68 [2.45-15.22]). The abdominal-pelvic location of pain was a protective factor (ORa = 0.28 [0.08-0.93]). Conclusion: We confirm in this Moroccan study the public health problem represented by oligoanalgesia. [ABSTRACT FROM AUTHOR]

Fatigue and fatigability are two identifiable dimensions in chronic pain clinic. Particularly, those dimensions seem sometimes to be at the forefront of the feeling of infirmity, expressed by the patient. Obviously, fatigue can become a huge obstacle to the pain's treatment and its relief. Furthermore, it gradually becomes an emotional and relational barrier for the painful patient, until he/she finds himself/herself in deep distress. [ABSTRACT FROM AUTHOR]

The article offers medical news briefs. Topics include preventive methods for preterm births, hospital use of ketamine in the management of "rebellious" chronic pain in the cases of suicidal crisis situation; and the relevance of prescribing or advising on physical activity in primary care for adult patients.

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Short hospital admission periods following pediatric inpatient surgery leave parents responsible for managing their child’s postoperative pain in the community following discharge. Little is known about the experiences of parents caring for their child’s postoperative pain after discharge home following inpatient surgery. Research examining parental postoperative pain management following their child’s day surgery has found that parents are challenged in their pain management knowledge and practices. Aims: This interpretative phenomenological analysis study sought to understand parents’ experiences caring for their child’s postoperative pain at home. Methods: Semistructured telephone interviews were conducted with seven parents between 2 weeks and 6 months after their child’s discharge from hospital. Results: Identified themes were coming home without support, managing significant pain at home, and changes in the parent–child relationship. Conclusions: Parents could potentially benefit from nurses optimizing educational interventions, from receiving ongoing support of transitional pain teams, and from assistance with return to school planning.

Background: In Canada, 41% of veterans experience chronic pain compared to the general population (20%). Many veterans with chronic pain also have comorbid disorders such as depression and posttraumatic stress disorder (PTSD), causing increased pain interference and disability. Aim: This study aims to investigate the effectiveness of a 4-week interdisciplinary pain management program at the Michael G. DeGroote Pain Clinic in Hamilton, Ontario, Canada, and to explore differences in pain experience and treatment outcomes between veterans and nonveterans in the program. Methods: Data were obtained from psychometric measures completed by 68 veterans and 68 nonveterans enrolled in the pain management program. By matching groups for age and gender, scores were compared between veterans and nonveterans. Outcomes investigated include catastrophizing, pain traumatization, stages of change, acceptance of pain, and program satisfaction. Multivariate analysis of variance (MANOVA) was conducted to examine session (admission–discharge) and group (veteran–nonveteran) differences, and independent t tests were used to examine differences in satisfaction measures. Results: Results showed that the program was effective for all participants, with significant differences between admission and discharge on several measures. However, veterans experienced significantly greater improvements in pain catastrophizing, kinesiophobia, pain traumatization, pain acceptance, stages of change, and pain coping, compared to nonveterans (P

Background Chronic pain affects one in five Canadians. Frontline health care providers (HCPs) manage the majority of patients with chronic pain yet receive minimal training to do so. The Extension for Community Healthcare Outcomes (ECHO) model™ is an education intervention aimed at HCPs (not patients) to support and improve care in underserviced communities. ECHO Ontario Chronic Pain and Opioid Stewardship (ECHO PAIN) is an adaptation of the ECHO model where the program goals are to support and improve chronic pain and opioid management in the province of Ontario, Canada. Aims This study aimed to investigate the perceptions of HCPs participating in ECHO PAIN. Methods Thirteen HCPs attending ECHO PAIN participated in in-depth semistructured phone interviews. Resulting data were analyzed through a qualitative descriptive lens. Results Analysis uncovered four themes: (1) HCPs’ motivation for joining ECHO PAIN, (2) interprofessional collaboration through ECHO PAIN, (3) the use of opioids for pain management, and (4) barriers and facilitators to participation and satisfaction in ECHO PAIN. HCPs joined ECHO PAIN because of their struggles managing their complex patients with chronic pain. HCPs also recognized the importance of interprofessional collaboration in pain management and shared examples of integration of different professional approaches in their clinical teams. Opioids for pain management remained a controversial issue, and ECHO served as an opportunity to decrease this knowledge gap. Finally, HCPs described how time constraints, organizational support, and session structure acted as barriers to their participation and satisfaction in the ECHO PAIN program; technology mediated satisfaction. Conclusions This study was the first in Canada to explore the motivations of HCPs in attending a chronic pain telementoring program as well as to examine the interprofessional effects of participation. HCPs increased their knowledge about management of chronic pain and increased their interprofessional approach.

Background Access to multidisciplinary pain management treatment in Canada is limited, with wait times up to 4 years. Stepped care approaches to mental health treatment have led to substantial reduction and elimination of wait times and may be applicable to chronic pain settings. There is no unifying framework for stepped care chronic pain programs. A systematic review of the efficacy of stepped care in chronic pain management conducted by the Canadian Agency for Drugs and Technologies reported varied results that may be due to heterogeneous stepped care models across facilities. Aim We propose a unifying framework for multidisciplinary stepped care chronic pain programs and present its application at The Ottawa Hospital Pain Clinic. The Ottawa Hospital stepped care framework is an eight-tiered approach that allows patients the opportunity to decide collaboratively with a health care professional which treatment program will best suit their needs for the management of chronic pain. As levels of stepped care increase, the time and resource commitment to each step will also increase. Treatment is stepped up or down, depending on patient needs. Method This is a descriptive case study. Results Implementing the interprofessional model of care with the stepped care program has eliminated wait times for access to The Ottawa Hospital Pain Clinic Interprofessional Chronic Pain Management Program and has improved communication between professions of the interprofessional team, resulting in better care for patients. Conclusion More research is needed to further develop and evaluate the clinical efficacy of stepped care to manage chronic pain.

Background With hundreds of pain management apps on the Canadian marketplace, it can be challenging for patients and clinicians to select effective and evidence-based mobile health (mHealth) apps that address pain from a biopsychosocial perspective. Aims Identify pain management apps within the Canadian app marketplaces to aid clinicians in recommending apps. Methods The iOS and Android marketplaces were systematically searched to identify pain management apps that included at least one core component of cognitive behavioural therapy (CBT) or mindfulness- and acceptance-based therapies. Selected apps were assessed using a researcher developed psychological components checklist, and the Mobile App Rating Scale (MARS). These two measures provided a robust assessment of the apps’ technical abilities and psychological principles being implemented. Results 508 pain management apps were identified, yet only 12 included a psychological component and were available for evaluation. On average, apps contained 8.10 out of 18 psychological components (SD = 2.77) with a MARS quality rating of 4.02 out of 5 (SD = .32). The most common psychological components were grounded in CBT, including psychoeducation, sleep hygiene, behavioural activation, coping skills training, and social support. Among the least commonly included components were goal setting, values and culture/diversity. Two-thirds of the apps involved health care practitioners in their development, but independent scientific review of apps was scarce. Conclusion The highest scoring apps (Curable, Pathways, Vivify) are highlighted for healthcare practitioners who may wish to recommend mHealth technologies to their patients for pain management. Future directions for research and app development are discussed.

A working group published good practice recommendations for acupuncture treatment in facial paralysis, combining data from the classic literature and expert consensus. The treatment takes into account the differentiation of the zheng. The patient's symptoms classically combine the appearance of the tongue with the characteristics of the pulse and aare grouped inti five zheng. This set makes it possible to distinguish four stages in the disease. The proposed treatment distinguishes five techniques: the threadlike needle, moxibustion, electro acupuncture, the use of the infrared lamp and facial massage. The main points are hegu (4LI) and local points; the secondary points are the points chosen according to the differentiation of the zheng. Applied early, acupuncture helps control progression of the disease, accelerate healing, relieve pain and reduce tearing. [ABSTRACT FROM AUTHOR]

The therapeutic use of cupping is present in several medical traditions. Based on clinical experience of over 37 years, we report here the therapeutic use of cupping in the treatment of pain related to pathogenic scars. [ABSTRACT FROM AUTHOR]

Background Postoperative pain management (POPM) appeared to be weak in Rwanda. Aims The aim of this study was to compare POPM measures in a teaching hospital between 2013 and 2017. Methods A two-phase observational study in 2013 and 2017. was conducted. Participants were recruited prior to major surgery and followed for two postoperative days. A numerical rating scale (0–10) was administered to all participants in both years, and the International Pain Outcomes questionnaire was administered in 2017. Recruitment, consent, and data collection were performed in participants’ preferred language. Results One hundred adult participants undergoing major general, gynecologic, orthopedic, or urologic surgery were recruited in 2013 and 83 were recruited in 2017. Fourteen percent of participants in 2013 and 46% in 2017 scored their worst pain as severe (>6; P

Background Some individuals with chronic pain do not seek care. This decision may be due to characteristics of the individual, pain, and/or their health professional(s). Aims This study aimed to identify and compare features of individuals with chronic pain, their pain and general health, and their health care professional between community-dwelling adults who did and did not seek care. Methods Randomly selected adults were mailed a study questionnaire that screened for chronic pain (pain persisting ≥3 months) and asked about their general well-being (Short Form [SF]-36), pain location (body diagram), pain intensity and characteristics (Leeds Assessment of Neuropathic Symptoms and Signs), experiences with health care professionals (Chronic Illness Resources Survey), and visits made to health professionals over the past year. Respondents were categorized as help-seeking (≥1 visit in the past year) and non-help-seeking (zero visits in the past year). Results Six percent of respondents (44/696) were non-help-seeking. These respondents differed in individual, pain, and health care professional characteristics when compared to those who did seek care. Specifically, when other variables were controlled, non-help-seeking individuals were less likely to be male (relative risk [RR] = 0.39, 95% confidence interval [CI], 0.18–0.86), report comorbid conditions (RR = 0.46, 95% CI, 0.22–0.98), report being treated as an equal partner in decision making (RR = 0.40, 95% CI, 0.18–0.93), and rate their health care professional as important to their pain management (RR = 0.39, 95% CI, 0.18–0.85). They were more likely to use over-the-counter medication to manage their pain (RR = 2.52, 95% CI, 1.14–5.58). Conclusions Experiences with health professionals play a role in determining whether an individual manages his or her pain independently. Future research should explore the safety of those who do not seek care.

Background One in five Canadians experience chronic pain, and interdisciplinary pain programs are well established as the gold standard of treatment. However, not all patients are ready to engage in interdisciplinary treatment for chronic pain. Aims The aims of this study were to (1) first demonstrate changes in patient-related outcomes after attending a publicly funded 8-week interdisciplinary pain program and (2) evaluate pain-related predictors of readiness for change. Methods The institution’s research ethics board approved this study. One hundred twenty-nine patients completed questionnaires on the first and last day of attending the program. Paired sample t-tests were utilized to evaluate the changes in patient-related outcomes after attending the program, and linear regressions were utilized to evaluate pain-related predictors of the stages of change. Results Postprogram, there were significant decreases in pain-related interference, fear of pain/re-injury, pain catastrophizing, and symptoms of stress, depression, and anxiety and a significant increase in wellness-focused coping and self-efficacy. Postprogram, patients also demonstrated lower scores in precontemplation and contemplation and higher scores in action and maintenance stages of readiness for change. In predicting precontemplation, fear of pain/re-injury was the sole predictor, and self-efficacy was the sole predictor of the contemplation, action, and maintenance stages. Conclusion These results demonstrate the short-term benefits of an 8-week interdisciplinary pain program. It is suggested that preprogram interventions targeting kinesophobia for individuals who are precontemplative and self-efficacy for others may be important to facilitate patient engagement.

Résumé: Chez les patients âgés dépendants, la douleur procédurale peut être favorisée par les soins quotidiens. La prise en charge antalgique est bien définie, cependant celle de l'anxiété associée est moins codifiée. Au sein de notre établissement, les médecins gériatres utilisent le midazolam injectable per os à faible posologie 30 minutes avant les soins douloureux. Objectif. Valider l'utilisation du midazolam per os en prémédication anxiolytique avant des soins quotidiens (soins d'hygiène, réfection de pansement...) en unités de soins de longue durée gériatriques. Matériel et méthode. Nous avons effectué une recherche documentaire en privilégiant les sources tertiaires d'information. Nous avons également étudié la faisabilité d'une préparation magistrale de midazolam administrable per os et proposé un protocole de prise en charge correspondant. Résultats. Deux méta-analyses ont démontré l'efficacité du midazolam – y compris per os – en prémédication anxiolytique d'actes douloureux anxiogènes. La faisabilité d'une suspension buvable de midazolam concentrée à 1 mg/mL a également été confirmée. Notre protocole d'utilisation prévoit que le midazolam per os soit utilisé 30 minutes avant le soin. La posologie doit être titrée (posologie initiale : 1 mg puis augmentation par pallier de 0,5 à 1 mg) et ne doit pas dépasser 5 mg. Ces éléments ont été intégrés dans une planche d'information. Conclusion. Ce premier retour d'expérience montre que l'utilisation de midazolam per os en prémédication anxiolytique avant des soins quotidiens est pertinente. Procedural pain in care homes is common and can be caused by daily care. Pain management is well defined but associated anxiety is less. Geriatricians of our care homes prescribe oral intravenous midazolam in this situation. Objective. Determine the appropriateness of oral midazolam as an anxiolytic premedication before daily care (personal hygiene, wound dressing) in care homes. Material and method. We performed a literature review, favoring tertiary information sources. We also studied the feasibility of a midazolam oral suspension and proposed a management protocol. Results. Two meta-analysis provide evidence that oral midazolam is effective in different kind of painful and anxious procedures. A stability study also confirmed the feasibility of a 1 mg/mL oral suspension. According to our management protocol, oral midazolam should be administered 30 minutes before the care. Doses should be established gradually (beginning from 1 mg, increasing by 0.5-1 mg) and should not exceed 5 mg. This information is compiled in a leaflet. Conclusion. This first feedback confirmed the relevance of oral midazolam in preventing anxiety associated with daily care. [ABSTRACT FROM AUTHOR]

Résumé: Nous avons vu dans une première partie la définition des troubles du comportement (TC), leurs significations possibles et l'adaptation de l'environnement de la personne en situation de handicap mental. Cette deuxième partie vise à aider les médecins généralistes à prendre en charge médicalement les TC : le handicap est une notion peu abordée durant les études médicales, et il n'existe pas à ce jour de référentiel clair et simple pour la prise en charge en médecine générale. We have seen in the first part the definition of behavioural disorders, their possible meanings and the adaptation of the environment of the person with an intellectual disability. This second part aims to help general practitioners to medically manage behavioural disorders: disability is a concept that is little discussed during medical studies, and to date there is no clear and simple reference framework for the management in general practice. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Self-diagnosis and pain management is a worldwide practice. The current study aims to determine the percentage of dental students and interns who self-diagnose and manage their dental pain and further establish the proportion of students who depend on various resources for diagnosing and treating their condition. Methods: a cross-sectional, self-administered questionnaire-based study was conducted among the dental students in and around Riyadh. The questionnaire consisted of three parts including: part 1-demographic data; part 2-pain and self-diagnosis; part 3-visiting the dentist and managing the pain. The data were analyzed using the Statistical Package for Social Sciences (SPSS version 22.0). Results: fifty four percent of the participants were involved in self-diagnosis and managed the pain by themselves. Seventy three percent of the respondents experienced teeth/gum discomfort or any symptoms of an oral health problem, of which 57% searched the symptoms they faced on the internet to arrive at a diagnosis. Besides, 35% of the interns considered internet to be a helpful tool for diagnosing their pain. 16% admitted that they have never visited a dentist. Conclusion: we found that a significant proportion of the participants self-diagnosed by using their background or resorting to the internet, at times consulting a dentist to confirm their diagnosis. The students from the health sciences background should refrain from this practice. Efforts should be made to make the population mindful of the potential risks linked to self-medication and diagnosis. Further research should be done with a larger sample size by including the students and interns from different institutions.

Foot and ankle pain and oedema are a common complaint among pregnant women. A range of hormonal and anatomical changes during pregnancy can cause modifications in foot and ankle's biomechanics and anatomy. The main foot and ankle pathologies encountered in pregnancy are progressive collapsing foot deformity, plantar fasciitis, heel pain, oedema, and fractures. Workup includes the use of radiological evaluation that could pose a risk to the fetus, depending on the gestational age. Treatment plans range from symptomatic conservative to surgical options and a multidisciplinary approach is often recommended and warranted. Our paper aims to present these different pathologies and propose a structured treatment plan to address them., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article

Psychedelics are emerging as a therapeutic innovation in psychiatry and their use in chronic pain is worth exploring. In fact, they can modulate the serotonergic system, affecting central pain sensitization mechanisms. Ketamine, used for chronic analgesia, can lead to pain reduction, but additional studies are needed to assess its longterm effectiveness. "Classic" psychedelics are recently attracting renewed interest for their potential effects on chronic pain. Despite limited studies, evidence suggests analgesic benefits, an effect on inflammation, and potential impacts on certain functional disorders. These results pave the way for further research in this ever-evolving field., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.